Anxiety medication dilemma take two

I'm still agonizing over the decision to go on medication. One, I'm incredibly impatient when it comes to medications working. Two, I'm worried about the side effects--yes weight gain which is always a fear. Three, I'm worried about the cost. Four, I'm worried it won't work and that my time will be wasted.

On the up side, a medication could work. I could perhaps think more clearly and process things better. I may not be as overwhelmed when faced with difficult decisions. It could possibly help with my continual vacillation between some denial and actual problem with exercising. :-/

So I bit the bullet and spent most of my morning making calls to psychiatrists' offices. I had a few names from my previous therapist. The two through the university who I wanted to see are booked until February and not taking new patients. I wouldn't even get to see them unless I saw their LCSW first and then had her refer me to one of their pdocs.

I called a few others that were on my insurance list. On one call, this guy was super nice and answered my questions and knew of one who worked with ED patients extensively. The funny thing was that I asked him if he knew of this other psychiatrist whom I'd called. His answer was that "she had been around forever, and given my age and problem, he highly suggested I went to see the ED pdoc." Hmmm, that kind of left me confused since she is the one I'm waiting to hear back from.

Another psychiatrist, I was able to speak with personally. She seemed very nice and worked with patients who were referred to her by my former therapist. The rest I called don't take my insurance with the exception of two psychiatric nurse practitioners.

As my analytical brain likes to do, I've made a list of the possible psychiatrists. This is the rundown, * indicates they accept my insurance.

Pdoc C. is an anxiety specialist who founded the Anxiety Foundation. He does both psychotherapy and pharmacotherapy and also uses animal assisted therapy. He has some experience working with eating disorder clientele. His fee, however, is a bit outrageous. Either he's really good, or he jacks his rates sky high.

Pdoc W. works with ED clients extensively and apparently worked under a well known ED researcher at the university. According to the guy I talked to who gave me his name, this pdoc, in his opinion, was the best ED one in town.

Pdoc L. was a a name given by my former therapist K. His specialty is addictions and is supposed to be a really nice guy. I think he also won some award a few years ago, voted as the best psychiatrist in town.

Pdoc G-R. is the one I spoke with. She's also worked with Ed clientele, though it is not her specialty. My former therapist, K. has referred several clients to her. She seemed very nice and even suggested if I had other names I wanted to run by her, to give her a call.

*Pdoc F. has also worked with ED clients. She is the one that the guy who I spoke to said had been around forever. I don't know if that is a good thing or a bad thing. I'm waiting to speak to her personally, as that is something she just does with all new possible clients.

*Pdoc Mc. or P. are nurse practitioners. My current therapist, C., has referred a few clients to them. She says that one is apparently blunt and gruff, but was able to find alternative meds that did not have weight gain as a side effect. The other she has not heard anything negative about.

Yes, I know this seems ridiculous. "It's just a psychiatrist" as one of my friends said. I called my mother to get feedback since she has been on what seems like every single medication known to mankind for depression. She tried really, but she wasn't very helpful.

See, this is the thing. I'm placed with a number of options in front of me, and then I have a hard time choosing. One part of me says I should just go through insurance as it would be cheaper. Another part of me thinks I should go for the specialty. Then, another part of me says I should bite the bullet for the high initial cost of the first appt. if the arrow points to them helping me more. Maybe I should just play spin the bottle?

Why am I making this so difficult? I think part of it is that I really want to be able to have an actual relationship with whatever pdoc I see. I don't want it to just be med management which unfortunately is how it mostly is since insurance companies have "ruined" the field of psychiatry. This is according to my mother's current pdoc.

The other thing is I think that the follow-up appts. would be a waste unless there were serious side effects going on. And I guess I'm just having trouble thinking about paying that much money for a mere 10-20 minutes at the max when you could just call and say how you were. I know most see pdocs much less frequently than a therapist but still.

Then, the really bad thing with all this (and why I'm really hating insurance at the moment) which I just found out is that any pdoc session would count toward my mental health coverage. Currently, I only have a ten session limit/year, so it cuts my therapy by at least two or more sessions. I can continue of course, it's just everything would be out of pocket, and I would not be able to go as frequently.

This is where everything stands right now, and I'm having a terrible time in deciding what to do. It's essentially the story of my life. :sigh: Does anyone have any special wisdom? Or want to commiserate with me?

Part one of anxiety medication dilemma can be read here.

By the way, my day ended up strangely. I went to the store to pick up a few items. When I got home to put the items away, I realized there was a pack of cigarettes in the bag! I have not a clue how they got in there. Hmm, maybe this is some sign? Just kidding, I seriously doubt someone is trying to tell me to just kill the anxiety with a few smokes.

Rant about insurance and other thoughts

Since my last post was about eating disorders and insurance, it reminded me of a few things. First off, I get really pissed off at insurance companies. Even for my 4 months of physical therapy I had this year for my hamstring and knee injuries, they covered maybe $400/month. I wound up paying nearly $3,000 out of pocket. For me, that's a lot of money on my budget. However, the interesting thing was that a month prior to physical therapy, I had some labs run (non Ed-related) which was covered without a problem--nearly $1,000. Sometimes I feel like why have this insurance when the coverage just seems like crap. And on individual policies, you can be really limited which further makes it difficult for any type of ongoing treatment mental health wise and beyond.

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Besides not being covered by insurance, there is the whole burden factor. For many, it is quite troubling. Individuals don't want to burden their families with the treatment of costs. This just makes the guilt even worse. At least for me it did.

Here's a vague conversation I had with my father in my mid-teens when the eating disorder had really taken force. He was very frustrated with me for not getting better/recovered. He said things like, "do you want to be emaciated looking, have a tube down your nose?" I replied with that I did not want that. And then he said, (this is jest of what he said, I can't remember it exactly word for word) "because you know, treatment costs a lot of money. I'd have to take money out of my savings. Do you want that?"

Talk about a major guilt trip. Of course, I answered with that I did not want that. The underlying factor of what I heard here is that I really wasn't worth it. Maybe it's one reason why I never got incredibly thin but remained just under the radar all the time. Even with my therapists, they'd ask something like "do you think you need to go inpatient?" I'd say I did not know, but what I really wanted them to say was, "yes, you need to go." At that time, I wanted the choice out of my hands. I thought if I was inpatient, maybe it would convince me that I was truly sick. That maybe if someone really advocated on my behalf, it would show me that I really was ill.

Inpatient never happened, at least not for the eating disorder (inpatient one time when I was 16 for suicidal tendencies which was a horrible experience other than finding coloring to be relaxing), but I'm beginning to realize that I really don't have to be inpatient to be better. Most of the time, the real healing only begins afterwards anyway.

Eating disorder lawsuits

We all know that insurance coverage for eating disorders is virtually non-existent or better put that we are often denied the coverage we really need and deserve. Last week, it was reported that the insurance company Aetna had settled their class action lawsuit among a number of eating disorder families. The Meiskins were the first to file the lawsuit in NJ, and 100 other families were listed thereafter. Aetna agreed to pay seven years worth of denied coverage to these families. Both parties have agreed to the settlement, but a judge still has to approve it. Let's hope he does. If it is approved, it really is quite a big victory for those with eating disorders who have had to battle insurance companies for treatment. Article here

Also to note, the Meiskins were featured back in 2007 on the TLC show ."Shalom in the Home." If you've never seen the show, Rabbi Schmuley uses mostly a family based approach to help his clients. His approach is centered on looking at the family as a whole and helping them rebuild relationships. I'm not sure the show is airing now, but I think there are other available videocasts you can download from the site.

Another class action case, also based in NJ, is with the insurance company, Horizon Blue Cross Blue Shield. The family of Janelle Smith say that the insurance company discharged Janelle when she was not healthy enough to be released. Within days of being discharged, she committed suicide.

Their lawsuit wants eating disorders to be covered like any other biologically based mental illness. The insurance company has supposedly agreed to reimbursing the Smiths The case goes to court this month. Article here

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It'll be interesting to see how this case turns out. So far 13 states have mental health parity laws which allows eating disorders to be covered like any other mental illness. I'm hoping with more cases like this and the convincing literature on genetics and biological components to eating disorders, it will bring bring about even more change. Hopefully, these small victories will turn out to become large ones. After all, sometimes change is slow, but with persistence, it can happen.

Eating disorder diagnostic criteria investigated

Will diagnostic criteria for eating disorders change?
According to this new study out of Rhode Island hospital and Brown University, researchers found that the majority of eating disorder individuals fell into the category of "EDNOS" or eating disorder not otherwise specified. This essentially means that these individuals did not fall strictly into the categories of anorexia or bulimia defined by the DSM-IV-TR.

This really doesn't surprise me at all. Experts have debated for years about the official criteria for eating disorders. Many have said it needed to be changed and the definition broadened as this study shows. I read awhile back that some eating disorder experts have suggested the removal of the "amenorrhea" criteria in anorexia for the new DSM-V, set to be published tentatively in 2012. In many cases, amenorrhea has been shown not to be that reliable of an indicator for anorexia. In this archived article from The New York Times, there is wide discussion about the "future of EDNOS." It will also be interesting to see whether other new subtypes will be considered such as "purging" disorder which made news back in September 2007 by Dr. Keel from University of Iowa.

Authors are even weighing in on naming and labeling, including Aimee Liu. On her website, she is actually having a naming contest asking people to think of a new name for "eating disorder." She will then address the Academy for Eating Disorders for "official" consideration.

If you speak to those with eating disorders, many get upset about the whole diagnostic criteria for eating disorders feeling that it's basically just a "label" and should not matter. Others feel that without an official diagnosis, their illness is not validated. Unfortunately, insurance companies want a label. To them, that label is important. It gives them the power to say what coverage they can allow whether or not it is actually sufficient for your treatment. Further, without a pure recognized "biological" basis, many insurance companies will not cover as much for treatment. Researchers are gaining ground on this area, but it has a long way to go. Many states have some form of a mental health parity law, but it varies state to state. This site gives a nice rundown of each state.

Whew, lots of information there. I went a little off tangent, but all of this relates to one another vastly as these are the issues of today.